A 51-year-old auto mechanic is referred to physical therapy because of pain symptoms in the left buttock and posterior thigh. The symptoms are worse when standing and reaching overhead for more than 15 minutes, which is what he does when working on a car that is up on the racks. Carrying heavy objects (> 50 lb), standing, and walking for more than a half-hour increase the symptoms. There is no precipitating incident, but the symptoms have been recurrent over the past year. Symptoms also increase with the recreational activity of backpacking. Symptoms ease when in the rocker recliner, lying on a couch with knees bent, or when hugging knees to chest.

Examination reveals swayback posture when standing; decreased flexibility in the low back, gluteus maximus, hamstrings (straight leg raising to 60°), and upper abdominals; and increased pain with backward bending. Strength of the lower abdominals is 3/5. He is able to do repetitive lunges and partial squats for a maximum of 20 seconds.

■ What is provoking the patient’s symptoms and signs? What are the functional limitations? What is the prognosis?

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â–  Identify impairment and functional outcome goals.

â–  Establish a program of intervention. Use the taxonomy of motor tasks discussed in Chapter 1 (see Figs. 1.6 and 1.7 and accompanying text) to develop a progression of exercises and tasks to progress this person to functional independence.

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